Pediatric expert consensus on the application of aspirin in Kawasaki disease
Shaanxi Province Diagnosis and Treatment Center of Kawasaki Disease/Children's Hospital of Shaanxi Provincial
People's Hospital, Children's Hospital of Shanghai Jiao Tong University, Beijing Children's Hospital of Capital Medical
University, Shengjing Hospital of China Medical University, Affiliated Hospital of Yan'an University, Expert Committee
of Advanced Training for Pediatrician, China Maternal and Children's Health Association, General Pediatric Group of
Pediatrician Branch of Chinese Medical Doctor Association, Pediatric International Exchange and Cooperation Center,
Shanghai Cooperation Organization Hospital Cooperation Alliance, Editorial Board of Chinese Journal of
Contemporary Pediatrics
Shaanxi Province Diagnosis and Treatment Center of Kawasaki Disease/Children's Hospital of Shaanxi Provincial
People's Hospital
Abstract:Kawasaki disease (KD) is one of the common acquired heart diseases in children aged <5 years and is an acute systemic vasculitis. After nearly 60 years of research, intravenous immunoglobulin combined with oral aspirin has become the first-line treatment for the prevention of coronary artery lesion in acute KD; however, there are still controversies over the role and optimal dose of aspirin. The consensus was formulated based on the latest research findings of KD treatment in China and overseas and comprehensive discussion of pediatric experts in China and put forward recommendations on the dose, usage, and course of aspirin treatment in the first-line treatment of KD.
Makino N, Nakamura Y, Yashiro M, et al. Nationwide epidemiologic survey of Kawasaki disease in Japan, 2015-2016[J]. Pediatr Int, 2019, 61(4): 397-403. PMID: 30786118. DOI: 10.1111/ped.13809.
Kim GB, Park S, Eun LY, et al. Epidemiology and clinical features of Kawasaki disease in South Korea, 2012-2014[J]. Pediatr Infect Dis J, 2017, 36(5): 482-485. PMID: 27997519. DOI: 10.1097/INF.0000000000001474.
5 Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2003)[J]. J Cardiol, 2004, 43(4): 263-283. PMID: 15125385.
Hsieh KS, Weng KP, Lin CC, et al. Treatment of acute Kawasaki disease: aspirin's role in the febrile stage revisited[J]. Pediatrics, 2004, 114(6): e689-e693. PMID: 15545617. DOI: 10.1542/peds.2004-1037.
Roberts G, Baker M, Leiblich H, et al. Hospitalisation and associated costs of gastrointestinal bleeding from primary prevention aspirin use in South Australia: a retrospective case series analysis[J]. Intern Med J, 2022, 52(2): 318-321. PMID: 35187830. DOI: 10.1111/imj.15687.
Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. PMID: 32641591. DOI: 10.1253/circj.CJ-19-1094.
Barrios Tascón A, Centeno Malfaz F, Rojo Sombrero H, et al. National consensus on the cardiological treatment and follow-up of Kawasaki disease[J]. An Pediatr (Engl Ed), 2018, 89(3): 188.e1-188.e22. PMID: 29778491. DOI: 10.1016/j.anpedi.2018.04.003.
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. PMID: 28356445. DOI: 10.1161/CIR.0000000000000484.
Miyata K, Kaneko T, Morikawa Y, et al. Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (Post RAISE): a multicentre, prospective cohort study[J]. Lancet Child Adolesc Health, 2018, 2(12): 855-862. PMID: 30337183. DOI: 10.1016/S2352-4642(18)30293-1.
Loomba RS. Comment on the paper by Suet al. entitled 'safety and efficacy of warfarin plus aspirin combination therapy for giant coronary artery aneurysm secondary to Kawasaki disease: a meta-analysis'[J]. Cardiology, 2015, 130(3): 164-165. PMID: 25676566. DOI: 10.1159/000369879.
Michihata N, Matsui H, Fushimi K, et al. Guideline-concordant treatment of Kawasaki disease with immunoglobulin and aspirin and the incidence of coronary artery aneurysm[J]. Clin Pediatr (Phila), 2015, 54(11): 1076-1080. PMID: 25573948. DOI: 10.1177/0009922814566932.
Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association[J]. Pediatrics, 2004, 114(6): 1708-1733. PMID: 15574639. DOI: 10.1542/peds.2004-2182.
Kobayashi T, Saji T, Otani T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial[J]. Lancet, 2012, 379(9826): 1613-1620. PMID: 22405251. DOI: 10.1016/S0140-6736(11)61930-2.
Huang YH, Hsin YC, Wang LJ, et al. Treatment of Kawasaki disease: a network meta-analysis of four dosage regimens of aspirin combined with recommended intravenous immunoglobulin[J]. Front Pharmacol, 2021, 12: 725126. PMID: 34456735. PMCID: PMC8397445. DOI: 10.3389/fphar.2021.725126.
Dhanrajani A, Yeung RSM. Revisiting the role of steroids and aspirin in the management of acute Kawasaki disease[J]. Curr Opin Rheumatol, 2017, 29(5): 547-552. PMID: 28661936. DOI: 10.1097/BOR.0000000000000425.
Dallaire F, Fortier-Morissette Z, Blais S, et al. Aspirin dose and prevention of coronary abnormalities in Kawasaki disease[J]. Pediatrics, 2017, 139(6): e20170098. PMID: 28562282. DOI: 10.1542/peds.2017-0098.
Suzuki T, Michihata N, Yoshikawa T, et al. High-dose versus low-dose intravenous immunoglobulin for treatment of children with Kawasaki disease weighing 25 kg or more[J]. Eur J Pediatr, 2020, 179(12): 1901-1907. PMID: 32862279. DOI: 10.1007/s00431-020-03794-2.
Jia X, Du X, Bie S, et al. What dose of aspirin should be used in the initial treatment of Kawasaki disease? A meta-analysis[J]. Rheumatology (Oxford), 2020, 59(8): 1826-1833. PMID: 32159800. DOI: 10.1093/rheumatology/keaa050.
Chiang MH, Liu HE, Wang JL. Low-dose or no aspirin administration in acute-phase Kawasaki disease: a meta-analysis and systematic review[J]. Arch Dis Child, 2021, 106(7): 662-668. PMID: 33172886. DOI: 10.1136/archdischild-2019-318245.
Dhanrajani A, Chan M, Pau S, et al. Aspirin dose in Kawasaki disease: the ongoing battle[J]. Arthritis Care Res (Hoboken), 2018, 70(10): 1536-1540. PMID: 29287309. DOI: 10.1002/acr.23504.
Kim GB, Yu JJ, Yoon KL, et al. Medium- or higher-dose acetylsalicylic acid for acute Kawasaki disease and patient outcomes[J]. J Pediatr, 2017, 184: 125-129.e1. PMID: 28043685. DOI: 10.1016/j.jpeds.2016.12.019.
Amarilyo G, Koren Y, Brik Simon D, et al. High-dose aspirin for Kawasaki disease: outdated myth or effective aid?[J]. Clin Exp Rheumatol, 2017, 35 Suppl 103(1): 209-212. PMID: 28079513.
Platt B, Belarski E, Manaloor J, et al. Comparison of risk of recrudescent fever in children with Kawasaki disease treated with intravenous immunoglobulin and low-dose vs high-dose aspirin[J]. JAMA Netw Open, 2020, 3(1): e1918565. PMID: 31899532. PMCID: PMC6991313. DOI: 10.1001/jamanetworkopen.2019.18565.
56 Wang H, Dong J, Cui X, et al. Cardiovascular system involvement[M]//Wang H. Paediatric Kawasaki Disease: Clinical Analysis and Cases. Singapore: Springer Singapore, 2021: 7-85.
Correction to: diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2019, 140(5): e181-e184. PMID: 31356128. DOI: 10.1161/CIR.0000000000000703.